Transcription
2022 BenefitsEnrollment Guide
Click this button throughout the guide tobring you back to the Table of ContentsTABLE OFCONTENTS3INTRODUCTION4BENEFIT HIGHLIGHTS6HEALTH PLAN11 PRESCRIPTION COVERAGE12 DENTAL PLAN13 VISION PLAN14 FLEXIBLE SPENDING ACCOUNTS16 LIFE INSURANCE17 TRAVEL ASSISTANCE17 DISABILITY COVERAGE18 403(b) RETIREMENT SAVINGS PLAN19 TIME AWAY21 EMPLOYEE LEAVE OF ABSENCE22 BACK-UP CARE & FAMILY SUPPORT23 EMPLOYEE ASSISTANCE PROGRAM23 WELLNESS PROGRAM24 EDUCATIONAL BENEFITS24 ADOPTION ASSISTANCE25 IDSHIELD & LEGALSHIELD26 REFERENCES & RESOURCES2
Medical College of Wisconsin Colleagues:At the Medical College of Wisconsin (MCW), wevalue our employees and their health – and we arecommitted to creating a healthy environment for ourworkforce. MCW’s employees value our institutionalculture and work environment, which support healthylifestyles and individual wellness. MCW sets anexample for partners on our three campuses as well asin the communities we serve by continuing to enhanceour engagement with our workforce on issues ofhealth, wellness and resilience.Additionally, MCW’s diversity is a source of strength – as equity and inclusion are infusedinto who we are, what we do, how we relate and work to achieve excellence in our missions,and how our knowledge is changing life. This organizational strength, known as InclusiveExcellence, comprises a set of connected strategic enablers that integrate diversity into ourculture – driving success and sustainability across our missions and the communities we bothdepend on and serve.MCW’s Wellness Program encourages our employees to commit to a healthy and activelifestyle. To that end, our Wellness Program offers opportunities that support employees’well-being through convenient virtual and on-site programs, education, resources and healthinterventions. These programs improve awareness, enhance motivation, build skills andprovide other opportunities to develop and sustain a positive environment. Additionally,MCW’s Benefit Package is designed to recognize and support the needs of our workforce. Ourpackage offers:Competitive and comprehensive benefit options.A program that considers diverse individual needs across all of the stages of life.Plans to help ensure long-term financial security for you and your family.We encourage you to take the time to read this Guide to better understand all of your optionsand to make informed decisions regarding your benefit elections. Only you can determinewhich benefits best fit your needs and those of your family.Kind regards,John R. Raymond, Sr., MDPresident and Chief Executive OfficerMedical College of WisconsinIf there are any program discrepancies contained in this Benefits Guide and enrollment materials,the official plan documents and the Summary Plan Descriptions shall prevail. Please refer to theplan-specific documents published by each of the respective carriers for detailed plan information.Elements of the MCW Benefits Program may be modified in the future to meet IRS rules or any otherchanges determined by MCW. If you have any questions, contact the Benefits team at 414-9558394 or by email at benefits@mcw.edu.The Benefits Guide illustrates highlights of the MCW Benefits Program including benefit costs.Employee benefits rights under this program are governed solely by the official documents and notthe information contained within this Benefits Guide.3
BENEFIT HIGHLIGHTSPlan YearBenefit EligibilityThe MCW benefits planyear begins on January 1and ends the followingDecember 31.1FT/PT Staff (.75 - 1.0 FTE)2PT Staff (.5 - .74 FTE)3FT/FPE Faculty (.5 - 1.0 FTE)4FT/FPE Staff Physicians (.5 - 1.0 FTE)Eligibility5FT/PT Instructor (.75 - 1.0 FTE)6PT Instructor (.5 - .74 FTE)Your benefit eligibility corresponds to yourFull-Time Equivalent (FTE) status. Use theBenefit Eligibility table below to determinewhich is applicable to you.7FT/PT Postdoctoral Fellow (.75 - 1.0 FTE)8PT Postdoctoral Fellow (.5 - .74 FTE)9FT Project Appointment (1.0 FTE)10Casual (.1 -.49 FTE)Your benefit eligibility class determines thebenefit plans for which you are eligible andyour contribution rates.BenefitEligible c Life13457Voluntary Life*13457Time Away1345Short-Term Disability1345Long-Term Disability1345Educational Benefits13Health Care Flexible Spending Account*134Dependent Day Care Flexible SpendingAccount*13IDShield & Legal Shield*1Mandatory 403(b)1Voluntary 403(b)Employee Assistance ProgramBack-Up 1234567895*Benefits that require employee enrollment action within 31 days of hire or during annual open enrollment period, to participate.4
Qualifying Life EventsDependent CoverageOnce you elect MCW’s benefits, your elections mustremain in effect for the duration of the plan year(January 1 through December 31).Dependents eligible for benefit coverage are legallymarried spouses, your dependent child(ren) orstepchild(ren) up to age 26 regardless of student ormarital status, and disabled adult child(ren). Pleaserefer to the summary plan descriptions for furtherinformation on each benefit offering.Generally, you will not have the ability to changeyour elections or terminate your benefits during themiddle of the plan year, unless you have experienceda Qualified Life Event (QLE). If you would like tomake a change to your benefits as a result of havingexperienced a QLE, please note that you must initiatea QLE in the benefits system, including uploadingrequired supporting documentation, within 31 daysof the event occurring. Failure to follow thisnotification requirement may result in your inabilityto make the changes you desire until the nextOpen Enrollment period.A list of specific QLEs under Section 125 of theIRS or HIPAA rules include:MarriageDivorce, legal separation, or annulmentChange in employee’s employment statusresulting in a loss or gain of eligibilityBirth, adoption or attaining legal custody ofa childDeath of a covered dependentGain or loss of other insurance coverageFMLA (unpaid)Significant change of insurance coverage orcontributionEntitlement to Medicare or MedicaidChild loses eligibility due to reaching the limitingage of the planAcceptable Proof of RelationshipSpouse: Marriage certificate and most recentfederal tax returnChild(ren): Birth certificate, adoption papers orlegal custodian papersNew Hire Enrollment GuidelinesAs a new benefit-eligible employee, you have importantbenefit decisions you need to makewithin 31 days of your hire date. The MCW BenefitsOffice offers you online resources to assist inmaking decisions about your benefits, including abenefits orientation presentation explaining the optionsavailable to you. To access the online presentation, visitthe benefits enrollment website at benefits.mcw.eduand enter the following information to log in:Username: Your MCW usernamePassword: Your MCW passwordClick on the icon in the New Hire Video box to viewthe new hire benefits presentation. After viewing thepresentation, you can immediately enroll for benefits orcome back at a later time to complete your elections.Remember, you have 31 days from your hire date tocomplete your benefit enrollment and you can go backinto the system to make changes any time during this31-day enrollment period.5
HEALTH PLANMCW offers two self-funded health insurance plan options: Basic and Enhanced. Both options include acomprehensive prescription drug program. Once you have made your election, coverage begins the first of themonth on or after your date of hire.You may see any physician or use any hospital you choose, but you will receive the greatest benefit when youchoose an in-network provider.Before obtaining care or undergoing a procedure, make sure you verify if your provider is in network or out ofnetwork, and the corresponding level of coverage you can expect. We encourage employees to choose in-networkproviders when possible. Certain procedures and/or treatments require pre-certification in order to be coveredunder the plan.NetworksSoutheastern WI Group (SE WI):Includes Dodge, Washington, Ozaukee,Jefferson, Waukesha, Milwaukee, Walworth,Racine, and Kenosha counties.Preferred Care Network (PCN): mcwpcn.comFroedtert, Children’s Hospital of Wisconsin, the Medical College ofWisconsin, and Froedtert South (Kenosha)Plan Highlights: Low Deductibles Low In-Network ParticipantCoinsurance (10%) Historically below marketpremium increases yearover yearYour dependent(s) residing outside of SE WI counties will be covered under the Non-SE WI group when his/herout-of-area address is included in the myBenefits enrollment system.Non-Southeastern WI Group (Non-SE WI):Includes all counties not listed above.Preferred Care Network (PCN): mcwpcn.comFirst Health Network: myFirstHealth.comNetwork of 5,000 hospitals and over one million healthcare professional service locations in all 50 states.Non-SE have accessto both PCN and FirstHealth Network.Coverage CategoriesMCW offers four coverage categories allowing youultimate flexibility in choosing who to cover:EmployeeEmployee Child(ren)You will receive an ID card fromHealthScope Benefits for your healthcoverage. ID cards are also availableon the MyHealthScope app and onhealthscopebenefits.com.Employee SpouseEmployee Spouse Child(ren)6
Plan Option 1: Basic Health PlanBasic Health PlanSoutheast (SE) WisconsinNon-Southeast (Non-SE) WisconsinIn NetworkOut of NetworkMCW Preferred Care Network (PCN)Out of NetworkMCW PCN / First Health NetworkOut of NetworkNo limit on essential health benefits; 2,000,000 limit on non-essential health benefitsAnnual Max BenefitEmployer / EmployeeEmployer / EmployeeIndividual Deductible 1,000 5,000Family Deductible 2,000 10,00090% / 10%50% / 50%Individual Total Out-of-Pocket Max(Deductible Coinsurance Co-Pays) 5,000 18,000Family Total Out-of-Pocket Max(Deductible Coinsurance Co-Pays) 10,000 36,000100%Deductible/CoinsuranceOffice Visit 30 co-pay then Deductible/CoinsuranceDeductible/CoinsuranceMental Health Office Visit 30 co-pay then list Office Visit 55 co-pay then Deductible/CoinsuranceDeductible/Coinsurance 30 co-pay then ible/CoinsuranceDeductible/CoinsuranceMember CoinsurancePreventive Care ServicesUrgent CareX-Ray, Labs, MRI/CT, etc.1Ambulance ServicesVirtual Clinic (minor illness/injury)Fast Care Co-PayEmergency RoomInpatient Hospital Admission 150 co-pay per occurrence, then In-Network Deductible/Coinsurance100%N/A 10N/A 150 co-pay, then In-Network Deductible/Coinsurance 250 co-pay, then Deductible/CoinsuranceRetail Drug Co-Pay (Tiers 1-5)Deductible/Coinsurance 100Pre-certification Penalty 2 15/ 35/ 80/ 140/ 170 and 5/month discount at Froedtert Pharmacies(except Specialty)Mail Order Drug Co-Pay (Tiers 1-3) 30/ 70/ 1601Prior authorization for certain outpatient, non-emergency MRI/CT scans required, 100 penalty forfailure to obtain pre-certification. Visit mcw.edu/PriorAuth for a full list.2Pre-certify at least 7 days prior to a planned Inpatient Hospital Admission, Bariatric Surgery, OrganTransplant Treatment, and Genetic Testing. For emergency (unplanned) admissions, certify within 48hours or next business day. Please review Summary Plan Description or visit mcw.edu/PriorAuth forcomplete list of services/procedures requiring pre-certification.7
Plan Option 2: Enhanced Health PlanEnhanced Health PlanSoutheast (SE) WisconsinNon-Southeast (Non-SE) WisconsinIn NetworkOut of NetworkMCW Preferred Care Network (PCN)Out of NetworkMCW PCN / First Health NetworkOut of NetworkNo limit on essential health benefits; 2,000,000 limit on non-essential health benefitsAnnual Max BenefitEmployer / EmployeeEmployer / Employee 500 3,000 1,000 6,00090% / 10%50% / 50%Individual Total Out-of-Pocket Max(Deductible Coinsurance Co-Pays) 4,000 15,000Family Total Out-of-Pocket Max(Deductible Coinsurance Co-Pays) 8,000 30,000100%Deductible/CoinsuranceOffice Visit 20 co-pay then Deductible/CoinsuranceDeductible/CoinsuranceMental Health Office Visit 20 co-pay then list Office Visit 50 co-pay then Deductible/CoinsuranceDeductible/Coinsurance 20 co-pay then ible/CoinsuranceDeductible/CoinsuranceIndividual DeductibleFamily DeductibleMember CoinsurancePreventive Care ServicesUrgent CareX-Ray, Labs, MRI/CT, etc.1 150 co-pay per occurrence, then In-Network Deductible/CoinsuranceAmbulance ServicesVirtual Clinic (minor illness/injury)Fast Care Co-Pay100%N/A 10N/A 150 co-pay, then In-Network Deductible/CoinsuranceEmergency RoomInpatient Hospital Admission 250 co-pay, then Deductible/CoinsuranceRetail Drug Co-Pay (Tiers 1-5)Deductible/Coinsurance 100Pre-certification Penalty2 15/ 35/ 80/ 140/ 170 and 5/month discount at Froedtert Pharmacies(except specialty)Mail Order Drug Co-Pay (Tiers 1-3) 30/ 70/ 1601Prior authorization for certain outpatient, non-emergency MRI/CT scans required, 100 penalty forfailure to obtain pre-certification. Visit mcw.edu/PriorAuth for a full list.2Pre-certify at least 7 days prior to a planned Inpatient Hospital Admission, Bariatric Surgery, OrganTransplant Treatment, and Genetic Testing. For emergency (unplanned) admissions, certify within 48hours or next business day. Please review Summary Plan Description or visit mcw.edu/PriorAuth forcomplete list of services/procedures requiring pre-certification.8
Health Plan ComponentsDisease Management ProgramAnytime CareVirtual ClinicThe Virtual Clinic can treat you at home for commonconditions (see below) and can even prescribemedications. This benefit offers a convenient wayfor you and your family to receive care after hoursor on weekends. Board-certified family practitionersprovide treatment through your webcam or over thephone without an appointment.MCW health plan participants and their covereddependents may use the Virtual Clinic for free whenyou enter your Health Member ID# from your HealthCard in the service key field. Those who are notenrolled in the medical plan may use the VirtualClinic for 49.Access is available at froedtert.com/virtual-clinicor through the Froedtert & MCW app on the AppleApp Store and Google Play. Any prescriptions yourprovider deems appropriate will be called in to yourlocal pharmacy and a visit summary will be sent toyou via email.Fast Care – No Appointment NeededThe Fast Care clinics provide easy access toaffordable care for adults and children older than18 months with no appointment necessary. Theclinics provide care for minor health problems (seebelow) in convenient locations with extended hoursof operation seven (7) days a week.MCW health plan participants and their covereddependents can use the Fast Care clinics for a 10co-pay. Basic laboratory tests completed on site areincluded. Those not enrolled in the health plan mayvisit a Fast Care clinic for 65.This free and confidential service provides excellentresources for health plan participants looking forhealth resources, nurse coaching and onlineeducation. The Disease Management Programprovides support for members with chronicconditions through a combination of nurse coaching,online messaging and online education.Gap ExceptionA Gap Exception can be requested on the rareoccasion that an in-network provider cannot performa service or refers you to a Center of Excellencedue to the complexity of your case. If approved byHealthScope Benefits, related claims will be paid atthe in-network level.Fertility Assistance – ProgynyMCW has partnered with Progyny to provide aninclusive family building benefit for every uniquepath to parenthood. We understand that the journeyto become a parent can by physically, emotionallyand financially challenging. With this in mind, ourbenefit called a smart cycle, has bundled togetherthe individual services, tests and treatments youmay need. The coverage is also not subject totraditional strict infertility medical guidelines whichallows coverage to be inclusive regardless of genderidentity or sexual orientation.The smart cycle will be customized based onyour unique needs for procedures such as In VitroFertilization, Intrauterine Insemination, andDonor Tissue Purchase.To find a Fast Care clinic, visitfroedtert.com/fastcare.Participants in the Non-Southeastern WisconsinGroup can also use in-network retail fast care cliniclocations in their area for a 10 co-pay.The Virtual and Fast Care Clinics can treat avariety of minor illnesses, including thesecommon conditions:Flu 9
Health Plan PremiumsTypeEmployee Monthly Premium1Basic Plan – Full-Time (1.0 FTE)2Employee Monthly Premium1Basic Plan – Part-Time Staff (.75-.99 FTE) & FPE2 FacultyEmployee 82.00Employee 107.00Employee Child(ren) 206.00Employee Child(ren) 268.00Employee Spouse 241.00Employee Spouse 313.00Employee Spouse Child(ren) 346.00Employee Spouse Child(ren) 450.00Enhanced Plan – Full-Time (1.0 FTE)1TypeEnhanced Plan – Part-Time Staff (.75-.99 FTE) & FPE2 FacultyEmployee 116.00Employee 151.00Employee Child(ren) 279.00Employee Child(ren) 363.00Employee Spouse 327.00Employee Spouse 425.00Employee Spouse Child(ren) 470.00Employee Spouse Child(ren) 611.00Tobacco-free rate displayed; 50/month tobacco and 75/month spousal surcharge not included in premiums listedFull Professional Effort (FPE): .5 - .99 FTEHealth Plan Premium ComponentsHealth Plan Premium AssistanceSpousal SurchargeMCW provides employees with financial assistanceto help lower the costs of health care premiums.You may choose to cover your spouse under the MCWmedical plan; however, you are subject to a 75 permonth surcharge if your spouse has other coverageavailable. During enrollment, you must certify in thebenefits system whether or not your spouse has othercoverage available.Tobacco / Nicotine-Free RateEmployees are eligible for the tobacco/nicotine-free rateif they and their covered dependents (age 18 ) do notuse tobacco products such as cigarettes, pipes, snuff andchew, or any type of electronic cigarettes (e-cigarettes),or vaporizers.To receive the tobacco / nicotine-free rate, you mustcertify that you and your covered dependents age 18 aretobacco and nicotine free during your new hire enrollmentin the benefits system, and all must remain tobacco andnicotine free for the plan year. If you and/or your covereddependents age 18 are tobacco users or use vaporizersor electronic cigarettes, an additional 50/month/familywill be added to your premium. You are responsible foridentifying you and/or your covered dependents’ tobaccoor nicotine use status during each annual OpenEnrollment period.MCW provides either 30% or 50% assistancepremium reduction based on IRS householdincome guidelines.To review the eligibility requirements, search“Premium Assistance” on InfoScope.If you believe you are eligible for the PremiumAssistance Program, you will need to complete anapplication and include a copy of your most recentfederal income tax Form 1040. Find the applicationon the HR Benefits InfoScope website or log intothe benefits system (benefits.mcw.edu).For more information, contact The Benefit ServicesGroup at 866-913-4853, option 1.MCW is committed to helping you and your covereddependents achieve your best health. The tobacco andnicotine-free health plan rate is available to all employees.If you and/or your covered dependent are tobacco usersor use vaporizers or electronic cigarettes, the EmployeeAssistance Program’s Tobacco Cessation CoachingProgram can be utilized to earn the tobacco andnicotine-free rate on your health plan.10
PRESCRIPTION COVERAGEPrescription drug coverage is a component of your MCW health plan. Your prescription benefits includedifferent pricing structures that enable you to control cost based on the types of medications used and thelocation where you fill your prescription.Mail-Order ServicesThe Express Scripts Home Delivery Pharmacy offersa convenient, cost-effective mail-order programavailable to all health plan participants. This programallows you to purchase a 90-day supply at a cost ofonly two co-pays of maintenance medications, andhave them shipped directly to your home.Maintenance PrescriptionsLocate a Participating PharmacyMaintenance medication prescriptions are limitedto two fills at a retail pharmacy. After two fills, theprescription is required to be filled as a 90-day supplyat either Froedtert Health, Walgreens, or through theExpress Scripts mail-order program. If a participantcontinues to fill his/her one-month supply medicationat a retail pharmacy, a charge of threeco-pays for the one-month fill will be applied.Froedtert Health Pharmacy(30-day / 90-day)Retail Pharmacy(30-day)Walgreens(90-day)Express ScriptsMail Order (90-day)Generic 10 / 30 15 45 30Preferred Brand 30 / 90 35 105 70Non-Preferred Brand 75 / 225 80 240 160Specialty Generic & Preferred Brand1N/AN/AN/A 140Specialty Non-Preferred Brand1N/AN/AN/A 170Prescription Type1For a listing of Express Scripts participatingpharmacies, go to express-scripts.com.For a listing of Froedtert Health pharmacylocations, please lable through Express Scripts Specialty Pharmacy only. Limited to a 30-day supply.11
DENTAL PLANMCW’s dental plan includes two plan options, Basic and Enhanced, that encompass varying levels of coverage.If you are a new hire, coverage begins the first of the month on or after your date of hire.Plan Highlights: Preventive Services do not apply towardsannual maximum No In-Network DeductibleID cards are available on themyCigna app and also onmycigna.com. Above market coverage for Basic and MajorServicesEnhanced PlanCalendar Year Deductible(Excludes orthodontia services)Annual Maximum(Excludes orthodontia and preventiveservices)Preventive ServicesOral services, X-rays, cleanings, topicalfluoride treatment to age 19, spacemaintainersBasic ServicesSealants to age 19, TeleDentist VirtualVisits, emergency care for pain relief, oralsurgery, fillings*, routine extractions, denturerepair and adjustments, denture relines andrebases, prefabricated stainless steel crownsand periodonticsMajor ServicesCrowns, inlays, onlays and endodontics (rootcanals)Prosthodontic ServicesImplants, bridgework and denturesOrthodontiaBasic PlanIn NetworkOut of NetworkIn NetworkOut of NetworkIndividual 0Family 0Individual 25Family 75Individual 0Family 0Individual 50Family 150 1,500 1,000100% no deductible100% afterdeductible100% no deductible100% afterdeductible100% no deductible80% after deductible100% no deductible50% after deductible80% no deductible50% after deductible80% no deductible50% after deductible50% no deductible50% afterdeductible50% afterdeductibleOrthodontia covers children to age 19. Planpays 50% (no deductible) of the coveredorthodontia services, up to a 1,500lifetime orthodontia maximum50% no deductibleN/A* Composite Fillings: Basic Plan anterior teeth only; Enhanced Plan anterior and posterior coverage.Dental Plan PremiumsTypeEmployee Monthly PremiumBasic Plan – Full-Time (1.0 FTE)EmployeeEmployee Child(ren)Employee SpouseEmployee Spouse Child(ren)Employee Monthly PremiumBasic Plan – Part-Time Staff (.75-.99 FTE) & FPE Faculty 14.00 32.50 40.50 54.50Enhanced Plan – Full-Time (1.0 FTE)EmployeeEmployee Child(ren)Employee SpouseEmployee Spouse Child(ren)TypeEmployeeEmployee Child(ren)Employee SpouseEmployee Spouse Child(ren) 18.00 42.00 52.50 71.00Enhanced Plan – Part-Time Staff (.75-.99 FTE) & FPE Faculty 20.50 47.00 58.00 78.50EmployeeEmployee Child(ren)Employee SpouseEmployee Spouse Child(ren) 26.50 61.00 75.50 102.0012
VISION PLANMCW’s voluntary vision plan includes two plan options: Exam Only and Exam Materials. If you elect to participatein the voluntary vision plan, you will be responsible for paying 100% of the premium. Once you have made yourelection, coverage begins the first of the month on or after your date of hire.Exam Materials PlanVSP ProviderVSP ProviderEye Exam(Every 12 months) 10 co-pay 10 co-payRetinal Screening 20 co-pay 20 co-payFrames(Every 24 months)Not Covered 175 allowance for a wide selection of frames; 225 allowance for featured frame brands; 95 Costco frame allowance Coveragefor RetinalScreeningsNot CoveredIncluded in prescription glasses Exclusivesavings andperks onVSP’sEyeconicwebsiteLenses (every 12 months)SingleBifocalTrifocalLens Enhancements (every 12 months)Standard ProgressivePremium ProgressiveCustom ProgressiveContacts (every 12 months)1Instead of glasses1Exam Only PlanNot CoveredNot CoveredPlan Highlights: Two Plansoffered 0 co-pay 95- 105 co-pay 150 - 175 co-pay 175 allowance; co-pay does not applyContact lens exam has a 50 co-pay (fittingand evaluation)Includes lens fitting fees.Note: Get the most of your benefits and greater savings with aVSP Network doctor. Call Member Services at 1-800-877-7195for out-of-network plan details.Diabetic Eyecare Plus ProgramThis program covers services related to diabetic eye disease, glaucoma and age-related macular degeneration(AMD). A retinal screening is available for eligible members with diabetes. Please note that there is a 20 co-paythat applies. Limitations and coordination with medical coverage may apply. Ask your VSP doctor for details.Vision Plan PremiumsExam Only PlanExam Materials PlanEmployee Monthly PremiumEmployee Monthly PremiumEmployee 1.10 8.14Employee Child(ren) 2.18 15.92Employee Spouse 2.16 15.78Employee Spouse Child(ren) 2.74 20.36TypeID cards are not needed;simply inform your provideryou have VSP. You mayprint an ID card from youraccount on vsp.com.13
FLEXIBLE SPENDINGACCOUNTSA Flexible Spending Account (FSA) allows you to set aside pre-tax dollars to pay for eligible health care anddependent care expenses. The advantage to participating in an FSA plan is that your contributions are not subjectto payroll taxes, which can result in substantial payroll tax savings. It is important that you use all contributionsyou make to the plan, as your contributions are subject to the IRS Section 125 “use-it-or-lose-it” provision. Further,account balances cannot be carried over from year to year. If you have any unused funds in your spending account atthe end of the year, your funds will be forfeited per IRS requirements. If you are a new hire, coverage begins the firstof the month on or after your date of hire.Health Care Flexible SpendingAccount (FSA)Health Care FSA accounts are used for unreimbursedmedical, prescription, dental, vision and other healthexpenses for you and your eligible dependentsincluding, but not limited to, the following expenses:Medical and dental plan deductibles,coinsurance paymentsOffice visit and prescription co-paysHealth Care FSA ContributionsYou decide how much money to contributein your FSA account based on your estimateof expenses for the plan year. The annualamount will be divided evenly and deductedon a pre-tax basis from your paycheck.Eye exams, glasses and contact lensesMaximum contribution: 2,750/yearDental and orthodontic expensesMinimum contribution: 100/yearOver-the-counter medicationsFeminine care productsWhen you enroll in a Health Care FSA plan, thetotal annual amount you elect is available to you onJanuary 1 or your benefits effective date if you are anew hire/status change.You cannot change the amount youcontribute to a FSA in the middle of a planyear unless you have a Qualifying Life Event.If any money remains in your FSA at the endof the plan year, federal law requires you toforfeit the balance.Enrollment ConsiderationsServices must be rendered between1/1 and 12/31, or your effective dateand 12/31.You must re-enroll in the FSA each year.Remember to submit claims on aregular basis.14
Dependent Care Flexible SpendingAccount (FSA)The Dependent Care FSA is a pre-tax savingsaccount for elder care and child care expenses. Thechild or elder care provider must declare the incomeon his/her tax return for dependent care servicesprovided. You may use the Dependent Care FSAonly to pay for dependent care that is required toallow you and your spouse to be gainfully employed.You must use the account for the care of an eligibledependent. Residential summer camp and nursinghome care are excluded.ContributionsYou decide how much money you want to put in yourFSA based on your estimate of expenses for the planyear. The annual amount will be divided evenly anddeducted on a pre-tax basis from your paycheck andcontributed to your Dependent Care FSA.Maximum contribution: 4,500/year (marriedcouples filing separately may each contribute upto 2,000/year)Minimum contribution: 500/yearEligible ExpensesExpenses from qualified daycare providers(those who provide their taxpayer ID numberor Social Security number and sign yourreimbursement form)Dependent care expenses that have beenincurred, not just paidEligible DependentsA child under age 13 for whom you take atax exemptionA spouse who is physically or mentallyhandicappedA child age 13 or older who is handicappedA parent who is incapable of caring for himself/herself, is living with you and whom you claimas a dependentTo qualify, an elderly spouse or parent must spend atleast eight hours per day in the participating employee’shousehold.Reimbursement Methods(Health Care FSA & Dependent Care FSA)When you have eligible expenses to be reimbursed,there are multiple methods you can use to obtainaccess to your funds:MCW providesDependent Care FSAparticipants with anannual matchingcontribution of 500.WEX debit card (mailed to your home addressafter you enroll)Online Account: Upload your itemized receipts atwexinc.com/login/benefits-loginMobile App: Take a photo of your itemizedreceipts and upload using the DiscoveryBenefits mobile appMail or fax a claim form15
LIFE INSURANCEBasic Life and Accidental Death &Dismemberment (AD&D)Basic Life and AD&
If you have any questions, contact the Benefits team at 414-955-8394 or by email at benefits@mcw.edu. The Benefits Guide illustrates highlights of the MCW Benefits Program including benefit costs. Employee benefits rights under this program are governed solely by the official documents and not the information contained within this Benefits Guide. 3
